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International Congress of Chinese Medicine Israel | 2012

Research Day

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ICCM 2012 | Research Day 21.3.2012


Time Table Time

Subject

09:30-09:40

Opening remarks

09:40-09:55

Anxiolytic Effect of a Novel Adaptogenic Treatment

09:55-10:10

Acupuncture and Chinese herbal treatment for women undergoing intrauterine insemination

10:10-10:25

The multidisciplinary approach for Urologic Chronic Pelvic Pain Diseases. "Assaf Harofeh" Medical Center

10:25-10:40

Reduction of pain level using acupuncture in a patient with chronic wounds. Macabbi Health Service

10:40-10:55

Treating post surgery pain with individualized acupuncture, "Bnei Zion" Medical Center

10:55-11:25

Break

11:25-11:40

Curcumin Add-on Therapy for Induction of Remission in Mild-to-Moderate Ulcerative Colitis, Sheba Medical Center

11:40-11:55

Acupuncture in Post stroke rehabilitation. The complementary Medicine service at the rehabilitation department at Tel Aviv "SOURASKY" Medical center.

11:55-12:10

The interrelationship of the nursing staff and the complementary medical team following introduction of complementary medicine in a surgery department at "Bnei Zion" Medical Center

Ofra Grimberg

12:10-12:25

Clinical Research in Meridian Acupuncture for the treatment Back and Neck Pain in an Emergency Department at "Assaf Harofeh" Medical Center

Amos Ziv M.Sc

12:25-13:15

Panel Discussion Where are we heading? Research and Integration of Chinese Medicine in Israel

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Speaker Dr. Yair Maimon, Amos Ziv M.Sc Nadav Kately Keren Sela M.Sc

Guy Polak

David Gilad

Haim Hen, Gur Kreindler

Nir Salomon

Golan Sharav

Dr. Yair Maimon, Amos Ziv M.Sc, Ramon Vellmen, Margalit Shilo, Dr. Moshe Frenkel, Dr. Elad Schiff, Dr.Shahar Lev Ari

ICCM 2012 | Research Day 21.3.2012


Anxiolytic Effect of a Novel Adaptogenic Treatment Nadav Kately Dip. Ac&Hbs In recent years anxiety disorders have reached epidemic proportions. Current treatments are of limited efficacy and are associated with a wide variety of side-effects. Therefore, the need for further examination of pharmacological agents is evident. One source may be traditional eastern herbal medicine. Thus far, hardly enough empirical research using western scientific methodology has been conducted for the evaluation of eastern herbal drugs. This study was aimed to fill this void and examine the effect of a novel adaptogenic treatment through experiments relying on known animal models of anxiety and measurement of related behaviors and biological indicators. In all experiments mice were randomly assigned into different groups of treatment:adaptogenic treatment (15, 30 mg/kg), conventional treatment (escitalopram 15 mg/kg) and a control group (vehicle). Drug administration was given for the duration of 21 days. In the first experiment mice were subjected to Maternal Separation (MS) paradigm during the postnatal period and to Unpredictable Chronic Mild Stress (UCMS) paradigm in adolescence. During adulthood mice were administrated with the abovementioned treatment and thereafter anxiety-related measurements were assessed. The second experiment was aimed to assess the treatment's efficacy while administered during an adverse experience in early life. In this experiment, mice that were previously exposed to post-natal stress (MS) were treated throughout the adolescence stress paradigm (UCMS). Anxiety-related indicators were then evaluated during adulthood. The results of those experiments indicate an anxiolytic effect of the novel adaptogenic treatment, suggesting a further examination of this mixture as a promising candidate for treatment of anxiety disorders.

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ICCM 2012 | Research Day 21.3.2012


Acupuncture and Chinese herbal treatment for women undergoing intrauterine insemination Keren Sela a, Ofer Lehavi b, Amnon Buchan b, Karin Kedar-Shalem a, Haim Yavetz b, Shahar Lev-ari a,∗ a Unit of Complementary Medicine, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St., Tel Aviv 64239, Israel b Fertility Research Institute, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Abstract Aim: To assess the effect of traditional Chinese medicine (TCM, acupuncture and medicinal herbs) as a therapeutic adjuvant to ovulation induction with intrauterine insemination (IUI) procedures and evaluate its contribution to pregnancy and “take-home baby” rates. Materials and methods: A comparative retrospective study was carried out in a university – affiliated municipal hospital. All women undergoing artificial insemination by donor spermatozoa (AID) and concomitantly treated with TCM were invited to participate. The enrolled women underwent weekly TCM in parallel with medical therapy. The treatment lasted between 2 and 36 cycles (equivalent to a time period ranging from one month to one year). The control group was comprised of women who underwent AID without TCM and whose data were retrospectively retrieved from hospital files. Pregnancy was assessed by human chorionic gonadotropin findings in blood 12–14 days after IUI. The birth rate was calculated during follow-up. Results: A total of 29 women aged 30–45 years were enrolled in the study. The historical control group included 94 women aged 28–46 years. Women who combined TCM with the procedures for undergoing IUI had significantly higher pregnancy (OR = 4.403, 95% CI 1.51–12.835, p = 0.007) and birth rates (OR = 3.905, 95% CI 1.321–11.549, p = 0.014) than the control group. Conclusions: TCM appears to be beneficial as an adjunctive treatment in IUI procedures. Randomized controlled trials are needed to further assess the role of acupuncture and herbs in this setting. © 2011 Published by Elsevier GmbH.

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ICCM 2012 | Research Day 21.3.2012


The multidisciplinary approach for Urologic Chronic Pelvic Pain Diseases. Guy Polak(1) Dip.Ac, Amos Ziv(1), M.Sc., Kobi Stav(2), MD Shiram Integrative Medicine Services, Assaf Harofeh Medical Center, Zeriffin (2) Department of Urology, , Assaf Harofeh Medical Center, Zeriffin Background:Painful Bladder Syndrome/ Interstitial Cystitis ( PBS/IC ) in men and women and Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CP/CPPS) in men, termed the Urological Chronic Pelvic Pain Syndromes (UCPPS) are characterized by pelvic pain and urinary symptoms.The term Urologic Chronic Pelvic Pain Syndromes ( UCPPS ) is used to refer to pain syndromes associated with the bladder (interstitial cystitis/bladder pain syndrome) and the prostate gland (Chronic prostatitis/chronic pelvic pain syndrome) Orchialgia (unknown testicular pain) and prostatodynia. UCPPS symptoms are variable and their pathophysiology is not known;There is no single effective treatment for UCPPS diseases, but there are several good treatments that work better when integrated. A multidisciplinary treatment is more accepted and popular.. Purpose:Implement Acupuncture and Chinese herbal medicine techniques as a combined multidisciplinary approach for UCPPS. Methods:Once a diagnosis of UCPPS is established an individual treatment plan should be carefully chosen for the individual patient. Our first chosen method is acupuncture. The patient gets acupuncture treatments twice a week for 5 weeks and then once a week for 5 more weeks. Acupuncture is performed bilaterally in most cases. Acupuncture points are selected for stimulating and balancing the disordered Meridians. Points are commonly selected form the Liver, Urinary Bladder, Spleen and Conception vessel channels. Back Shu points are selected according to organ and functions and in addition as nerve stimulation. Other CAM disciplines that we use in UCPPS are Reflexology and Naturopathy. Excepted outcome: We expect to gather information on the effectiveness of this integrative approach for relief of UCPPS from 40 patients from the department of Urology in Asaf Harofeh Medical Center. Effectiveness will be assessed by means of questioning forms such as Chronic Prostatitis Symptom Index (cpsi) and International prostate symptom score (IPSS) and by life quality SF36 questioners. Conclusions:Patients and physicians are open to the integrative treatment approach of UCPPS. Further information is currently being gathered. Eventually, A multidisciplinary approach, may turn out to be one of the foundation stones for treating Urologic Chronic Pelvic Pain Syndromes

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ICCM 2012 | Research Day 21.3.2012


Reduction of pain level using acupuncture in a patient with chronic wounds. David Gilad1, Dany Rosen1, Roni Alexandrovsky1, Wassim Zaher1, Hanna Kaufman1. 1 Maccabi Health Services (Haifa, ISRAEL) Aim: Reduction of pain level using acupuncture in a patient with chronic wounds. Method: An 80 y/o female having chronic leg ulcers for 5 years was treated weekly at a "one stop multi-disciplinary clinic". She had three calf ulcers, Hypertension and Atopic Dermatitis, and was also under Hyperbaric Therapy conjointly with her "standard of care". Her severe pain was not alleviated by conventional analgesics; therefore an acupuncture treatment was added once a week, using 12 needles (30x0.18 mm) for 30 minutes. Assessment tools: 1. Visual Analog Scale; 2. "FOTO" = Focus On Therapeutic Outcomes; 3. Measurement of wound dimensions. Results: After 12 treatments, her VAS lowered from "10" to "1" and her FOTO score increased from "0" to "40". We noticed an acceleration of wound healing. Analgesics were reviewed and lowered by 40%. Discussion: The above outcome led us to initiate a research which includes difficult healing wound care pain level, wound dimensions and activities of daily living function, and is planned to be completed by the end of 2011. Two approaches of acupuncture in our research: 1. Traditional, using "Key Points" along the Meridian system. 2. "Surround the Dragon", which uses needles around the margins, into the intact skin. We cautiously predict that the first approach will mainly improve the pain level and the ADL's. The second one will mainly improve the wound size. Anticipated benefits: 1.Safety 2.Efficacy 3.reduction of conventional medication.

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ICCM 2012 | Research Day 21.3.2012


Treating post surgery pain with individualized acupuncture Kreindler G, Hen H, Attias S, Arnon Z, Schiff E. Complementary-Integrative Surgery Service, Bnai Zion Medical Center. Pain is a common post-operative symptom that is induced by the surgical intervention itself. Protocols that attempt to prevent and treat post-operative pain (POP) have been devised with the emphasis on anesthetics choice, and intra-operative blocks. Several Complementary Alternative Medicine (CAM) modalities have also been suggested for the treatment of POP with varying degrees of success, such as guided imagery, hypnosis, and acupuncture. Acupuncture is well known in treating a wide variety of pain related conditions. The use of acupuncture for treatment of pain is rapidly growing throughout modern societies. For the past year and a half a CAM service has been integrated at the surgery department in Bnai Zion Medical Center. Five practitioners provide CAM treatments to relieve patients from common perioperative symptoms such as pain, nausea, anxiety etc. Treatment effectiveness and safety are documented using validated quantitative and qualitative methodologies. During this time period we gained extensive experience in the treatment of POP. We utilized Traditional Chinese Medicine (TCM) diagnostic techniques in order to categorize the underlying TCM syndrome causing the manifestation of pain in each patient. Thereafter, acupuncture points were chosen according to the underlying syndrome, hence tailoring an individualized treatment. We hypothesized that this approach will provide better symptomatic relief of POP as compared to standardized acupuncture. Patients undergoing individualized acupuncture reported the severity of POP on a VAS scale before, and approximately two hours after treatment. In our presentation we will discuss outcomes of our approach, as well as provide sub-group analysis of effectiveness of acupuncture for POP according to TCM syndromal diagnosis. We will conclude that integration of TCM in hospitals should emphasize maintaining its traditional context hand in hand with appropriate rigorous research methodologies.

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ICCM 2012 | Research Day 21.3.2012


Curcumin Add-on Therapy for Induction of Remission in Mild-to-Moderate Ulcerative Colitis: A Prospective, Randomized, Placebo-Controlled, DoubleBlind Study Alon Lang, Nir Salomon, Uri Kopylov, Shomron Ben-horin Dept. of Gasteroenterology, Sheba Medical Center, Tel-Aviv University, Israel. Study protocol: Introduction and background:Ulcerative colitis (UC) is a chronic inflammatory disease resulting in increased morbidity in patients. The current standard treatment for mild to moderate UC (MTMUC) includes 5-aminosalicylic compounds (5ASA) such as mesalamine, yet some patients continue to experience disease symptoms and flare-ups. These patients require higher dosages of 5ASA medications and in many cases escalate to steroid and/or immuno-suppressant therapy which entails higher risk of hazardous side effects. Curcumin, an active ingredient of the herb Rhizoma Curcuma Longa, has been extensively studied in the context of inflammatory diseases. Studies have demonstrated its efficacy in reducing chemically induced colitis in animal modelsi ii . In humans, a controlled study using curcumin as an adjunct therapy to 5ASA medication has shown it to be superior to placebo in maintaining remission in MTMUC patientsiii. These data provides basis for investigating an integrative approach to optimize the current standard treatment in MTMUC patients using curcumin add-on therapy for inducing remission in an active disease state. Methods:A prospective, randomized, placebo-controlled, double-blind study assessing oral curcumin add-on therapy in patients with active MTMUC. Primary outcomes:Induction of remission (defined as score of ≤ 5 in the Simple Clinical Colitis Activity Index (SCCAI)). Secondary outcomes: 1. Significant improvement (defined as drop of ≥1.5 in SCCAI) 2. Significant endoscopic improvement (defined as drop of ≥1 in Mayo score) 3. Significant improvement in Inflammatory Bowel Disease Questionnaire (IBDQ). Inclusion criteria: 1. Confirmed histological diagnosis of UC. 2. Age 18-70 years. 3. Disease activity score of >5 and ≤13 in the SCCAI. 4. Patients on stable maximal 5ASA medication dose for at least 4 weeks prior to inclusion. 5. Patient on stable immuno-suppressant medication dose for at least 3 months prior to inclusion. 6. No concomitant serious renal, hepatic, cardio-vascular or metabolic disease. 7. Able and willing to give written consent.

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ICCM 2012 | Research Day 21.3.2012


Intervention: Patients diagnosed with MTMUC who meet the inclusion criteria are randomized between two treatment arms in a 1:1 ratio. Treatment arms are (1) concurrent medication + curcumin and (2) concurrent medication + placebo. Randomization of patients is stratified based on their current treatment, i.e. containing immune-modulators (Azathioprine or 6-MP), or not. Study medication is administered to both treatment arms for 4 weeks. All patients undergo assessment at inclusion and conclusion of study period using validated endoscopic and nonendoscopic disease activity indexes (Mayo score and SCCAI respectively). Discussion: "First-line" treatment of MTMUC consists of oral and topical 5ASA medication. Patients who continue to experience disease symptoms often require "second-line" immuno-suppressing therapy which entails more severe and hazardous side-effects. The rational of our study is to investigate an integrative clinical modality to optimize this "firstline" treatment, reduce morbidity and perhaps need for escalating pharmacological intervention in these patients. Study status:This study is currently recruiting patients at the central site in the gastroenterology department in Sheba Medical Center, Israel.

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ICCM 2012 | Research Day 21.3.2012


Acupuncture in Post stroke rehabilitation Review of randomized trials and clinical insights from The complementary Medicine service at the rehabilitation department at Tel Aviv "SOURASKY" Medical center. Assaf Feldman , Golan Sharav , Lev-ari Shahar The Complementary medicine service, Rehabilitation department, Tel Aviv "Sourasky" medical center More than 700,000 people suffer from stroke every year on the United States. Stroke is divided in to two types. The first is ischemic stroke, meaning death of brain cells due to impaired blood flow resulting in insufficient supply of oxygen and nutrients. The second type refers to hemorrhagic stroke where intracerebral bleeding occurs due to rupture of a blood vessel within the brain. The aim of this review to examine the efficacy of acupuncture through documented clinical trials on this matter, and evaluate its practical implementation. The Complementary medicine service in Rehabilitation department on Tel Aviv "Sourasky" medical center has treated patients in this field for more than 10 years. In our service hospitalized patients are treated in a short period right after the stroke has occurred. We believe that commencing treatment close to the event enables a unique opportunity to achieve efficient results. Understanding of the state of art research is essential for successful implementation of complementary medicine service in a hospital setting.

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ICCM 2012 | Research Day 21.3.2012


The interrelationship of the nursing staff and the complementary medical team following introduction of complementary medicine in a surgery department Grimberg O, Attias S, Catz M, Hen H, kreindler , Schiff E. Complementary-Integrative Surgery Service, Bnai Zion Medical Center. While complementary medicine (CM) is in extensive use, assimilation of its systemic use in hospitals is still rare. Approximately two years ago, CM services were introduced into a general surgery department at the Bnai Zion Hospital in Haifa, Israel. One of the most important interfaces that exist in the work of the service in this setting is the nursing personnel. Therefore, great emphasis has been placed on organizational processes that allow for proper assimilation of the service, while reducing resistance to it and turning it into a service that is well accepted by the medical-nursing staff and patients, alike. Six months after instating the CM services in the surgery department, a questionnaire was administered to all members of the nursing staff (n=20) so as to ascertain their attitude towards CM. The questionnaire was constructed from closed questions with a Likert 1-7 scale, as well as from open questions. Results were based on averages, standard deviations and qualitative content analysis of answers verbalized freely. After processing the questionnaire, a focus group was conducted with the nursing staff in order to further clarify the significance of the results obtained. The key findings indicate a favorable attitude in principle towards the CM services in the department. This positive attitude is ascribed to a correct series of actions taken for familiarization with the new service and to its successful assimilation by the CM service's management and the surgery department's head nurse. However, from the questionnaire analysis, certain criticism and points suggesting improvements also emerge. These points indicate some problems in the communication flow between the parties; differences in perceptions of CM by the nurses versus the CM providers; difficulties in the everyday routine of the nursing staff due to the nature of the work done by the CM therapists in the service; a desire to receive more and better tools for directing suitable patients for CM treatment; and, finally, a need for feedback on treatments already provided. Successful integration of CM in the surgery department is feasible and may serve as a model for instating complementary medical services in hospital departments, in general. This change requires organizational readiness and long-term supervision on the part of the key players in the medicine and nursing staffs in the various departments. Improving interpersonal communication, carrying out appropriate staff training and analyzing innerorganizational processes all serve as tools for successful assimilation of this service in hospital departments. 11

ICCM 2012 | Research Day 21.3.2012


Efficacy of an Integrative approach Utilizing Acupuncture for the treatment Back and Neck Pain in an Emergency Department Setting- Results from a Randomized Controlled Trial A. Ziv(1), Y. Moritz(1), G.Polak (1), A. Fromm(1), R. Cardush(3), M. Sharist(2), Y. Mirovsk(3)i, S. Bar Sham(2) (1) Shiram Integrated medicine Services, (2) Departent of Emergency Medicine, (3) Orthopedic Department B. Asaf Harofeh Medical Center, Affiliated with Sackler School of Medicine Tel Aviv Israel Background and Purpose : Musculoskeletal pain is a common complaint for patients attending hospital emergency department (ER). Acupuncture is commonly used by the general population for the treatment of musculoskeletal disorders and specifically for back and neck pain. The purpose of this study is to compare an integrative approach utilizing acupuncture as an add-on therapy to medication to medication alone for the treatment of simple back and neck pain in patients attending the ER. Methods: 67 patients were randomly assigned to either an Integrated treatment group consisting standard ER care in conjunction to real acupuncture treatment, Placebo Control group consisting of standard ER care in conjunction with placebo acupuncture, no treatment control consisting of standard ER care alone. The primary endpoint was change in pain score reported Numeric Rating Scale (NRS). Secondary endpoints were change in back and neck range of motion as measured by goniometer degrees, anxiety and somatization as reported by SCL questionnaire and overall satisfaction. Results: Similar NRS pain score reductions were observed in all three groups after standard ER medication (-1.48 in real acupuncture, -1.57 in placebo acupuncture control and -1.4 for no treatment control; in between group p=0.123). Greater NRS additional pain reductions were observed in real acupuncture group compared to placebo and no treatment groups (-2.58, -0.83, -0.68; between group p<0.001 for real acupuncture, placebo acupuncture and no treatment respectively). Between group NRS score reductions were only significant in real acupuncture (mean real Vs. no treatment: -1.9; P<0.001, mean real Vs. placebo: -1.45; p<0.001, mean placebo Vs. no treatment -0.14; p=0.73). Real acupuncture group demonstrated greater neck range of motion compared to placebo acupuncture and no treatment (27, 7.3, 3.7; between group p=0.004 for real acupuncture, placebo acupuncture and no treatment respectively). Real acupuncture and placebo acupuncture groups demonstrated a decrease in anxiety SCL score and an increase in overall satisfaction with ER service compared to no treatment group. Conclusions: In this randomized controlled trial, real acupuncture showed significant pain reduction and increased range of motion and seems to be an effective add-on treatment in patients visiting ER for acute back or neck pain.

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ICCM 2012 | Research Day 21.3.2012


ICCM2012- research day